Form Fl 684 PDF Details

If you're like most people, your New Year's resolutions probably included a few goals related to your personal finances. Perhaps you wanted to save more money, get out of debt, or invest in your future. While these are all important goals, they can be difficult to achieve on your own. That's where Form Fl 684 comes in. This form is used to apply for Florida residency status, which can help you take advantage of a number of tax benefits and other incentives. Keep reading for more information about how to complete Form Fl 684 and what it can do for you.

QuestionAnswer
Form NameForm Fl 684
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesorder fl declaration form, order insurance declaration, form 684, request order health

Form Preview Example

FL-684

PETITIONER / PLAINTIFF:

RESPONDENT / DEFENDANT:

OTHER PARENT:

CASE NUMBER:

(THIS IS A REQUEST, NOT AN ORDER)

I REQUEST THE FOLLOWING ORDERS FOR:

Name of child

Date of birth

Name of child

Date of birth

1.

2.

PARENTAGE. If not previously established, a judgment that you are the parent of the children named above.

CHILD SUPPORT. Monthly child support based on the state guideline. (An Income Withholding for Support (FL-195/OMB No. 0970-0154) will be issued.)

a. This is a request for a change to an existing order

(1)filed on (date if known):

(2)ordering (specify):

b.Child support to commence

(1)on the date this request was mailed or given to you.

(2) effective (specify):

c.Other (specify):

3.

HEALTH INSURANCE COVERAGE

4.

5.

If not previously ordered, an order that you provide health insurance for each child named above and an order that you complete the attached health insurance form and immediately return it to the local child support agency.

NOTICE: Your employer or other person providing health insurance will be ordered to enroll the children in an appropriate health insurance plan if you are found to be the parent, and a National Medical Support Notice will be issued.

FEES AND COSTS

 

 

 

Fees: $

 

 

 

Costs: $

PROPERTY RESTRAINT

 

 

 

 

 

 

 

 

Petitioner/plaintiff

 

 

Respondent/defendant

 

Other parent

 

 

 

 

be restrained from transferring, encumbering, hypothecating, concealing, or in any way disposing of the following property (specify):

 

 

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Form Adopted for Mandatory Use

REQUEST FOR ORDER AND SUPPORTING DECLARATION

Family Code §§ 215, 3751, 3761,

Judicial Council of California

3900-3901, 4001-4062, 4007, 4009, 4014,

FL-684 [Rev. January 1, 2010]

(Governmental)

4050-4076, 4200-4204, 7551,17304, 17400,

17402,17404, 17406,17422 www.courtinfo.ca.gov

FL-684

PETITIONER / PLAINTIFF:

RESPONDENT / DEFENDANT:

OTHER PARENT:

6. OTHER (specify):

CASE NUMBER:

7.

FACTS IN SUPPORT of this request are:

contained in an attached declaration.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF PERSON REQUESTING THESE ORDERS)

FL-684 [Rev. January 1, 2010]

REQUEST FOR ORDER AND SUPPORTING DECLARATION

(Governmental)

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